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New York's In-Home Medicaid Pathways, Explained

Managed Long Term Care (MLTC) and the NHTD waiver are New York's primary Medicaid routes for care delivered at home rather than inside a facility.

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Short answer

New York pays for in-home long-term care mainly through Managed Long Term Care (MLTC) and the Nursing Home Transition and Diversion (NHTD) Medicaid waiver. Neither pays for assisted living room and board -- both are for services delivered at home.

Managed Long Term Care (MLTC)

MLTC is New York's managed-care delivery system for Medicaid long-term care: PACE (age 55+) or MLTC Partial Capitation / Medicaid Advantage Plus. Enrollment has been mandatory in New York City, including Richmond County, since 2012 -- NYC was the first region in the state to require it.

Nursing Home Transition and Diversion (NHTD) Waiver

NHTD is a 1915(c) Medicaid HCBS waiver administered through NYSDOH Regional Resource Development Centers, for Medicaid-eligible people 65+ (or younger with a disability) assessed as needing nursing-home-level care, to receive services in the community instead.

Who administers it locally

NYC Aging (DFTA) and the local NY Connects access point (CASC, (718) 489-3954) can help a Staten Island family start either process.

Source: NYSDOH Managed Long Term Care

Source: NYSDOH NHTD Waiver

Questions families ask

How do I check a Staten Island facility's inspection history myself?

NYS Health Profiles publishes free license status and inspection history for every Adult Care Facility at profiles.health.ny.gov/acf, and for every nursing home at profiles.health.ny.gov/nursing_home. Search by region, county, facility name, or service type; nursing home records also include the federal CMS star rating.

What's the difference between an Adult Home and an Enriched Housing Program in New York?

Both are base-level Adult Care Facility license types under NYSDOH, but Enriched Housing Programs are generally structured around apartment-style independent units with supportive services, while Adult Homes are typically more institutional in layout. Either can add ALR certification on top to become licensed for assisted-living-level care.

Does New York rate assisted living communities the way it rates nursing homes?

No. Federal CMS star ratings apply only to Medicare/Medicaid-certified nursing homes, published at profiles.health.ny.gov/nursing_home and on CMS Care Compare. Assisted living and memory care communities in New York do not carry CMS star ratings -- the only public quality record for them is the NYS Health Profiles inspection history.

What is Managed Long Term Care (MLTC), and is it mandatory on Staten Island?

MLTC is New York's Medicaid managed-care delivery system for long-term care -- either PACE (age 55+) or MLTC Partial Capitation/Medicaid Advantage Plus. Enrollment has been mandatory in New York City, including Richmond County/Staten Island, since 2012 under Medicaid Redesign Team Initiative #90, approved August 31, 2012.

What is the NHTD waiver, and how is it different from MLTC?

The Nursing Home Transition and Diversion (NHTD) waiver is a Medicaid 1915(c) home- and community-based services waiver, administered through NYSDOH Regional Resource Development Centers, for Medicaid-eligible people 65+ (or younger with a disability) assessed as needing nursing-home-level care who want to receive services in the community instead. MLTC is a managed-care delivery system; NHTD is a specific waiver program.

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